Posts Tagged ‘children’

Because there were almost no data for treatment of H pylori eradication failures in pediatrics, recommendations stem largely from adult data. The present recommendation for rescue therapy is to administer a second course of alternate PPI triple therapy (PPI-CM if PPI-CA was used first or vice versa) or a quadruple therapy of PPI-BMT . While […]

Quinolone triple therapies, when used in combination with a PPI and either amoxicillin, tinidazole or clarithromycin, have intention-to-treat eradication rates of approximately 90% in adults; however, the safety of quinolones in pediatrics has not been established. Another regimen, a one-week quadruple regimen with a PPI, amoxicillin, clarithromycin and metronidazole, eradicated 94% of H pylori infections […]

Previous consensus statements for North American children have recommended one to two weeks of treatment with PPI-CA or PPI-CM, which reflect recommendations for adults. Although one- to two-week treatment with PPI-CA eradicated 84% of H pylori infections in trials in Northern Europe, Asia and the Middle East, and appears to be safe and readily available […]

Only two studies were identified that reported eradication proportions with second-line treatment. After the initial treatment failure using amoxicillin and cimetidine or cimetidine alone, or bismuth and metronidazole in combination, only 12.5% and 41.2% of H pylori infections were eradicated with rescue therapies containing a PPI with clarithromycin and a nitroimidazole for one week, or […]

While data were sparse for pediatric studies, treatment regimens in head-to-head studies were consistently more efficacious when the strain of H pylori was sensitive to the drugs in the regimen (Figure 4). In five studies that reported treatment efficacy by clarithromycin resistance, 83% to 100% of clarithromycin-sensitive H pylori infections, versus 0% to 56% resistant […]

The highest reported prevalence of primary metronidazole resistance (78.4%) was in Mexico. Prevalence of secondary metronidazole resistance was 4% in Australia, 30% in Belgium and 52% in France. The prevalence of primary clarithromycin resistance in children was lower than metronidazole resistance in Europe, where it ranged from 6% to 45%; in the United States, the […]

Only mild adverse events have been observed in H pylori treatment trials in children, but the manner in which adverse events were recorded and the occurrence of adverse events varied greatly between studies (unpublished data). Adverse events were observed in 0% to 34% of subjects given a dual therapy over one to six weeks of […]

However, in the United States, only 68% of infections were eradicated using two-week PPI-CA treatments. Two-week therapy with a bismuth compound, amoxicillin and metronidazole (BAM), given in developed countries outside of Spain, eradicated H pylori in more than 80% of children. A PPI, macrolide and a nitroimidazole regimen (PPI-MacN) typically eradicated less than 80% of […]